| 摘要: | 目的 女性一生當中有幾個階段特別容易好發焦慮與失眠，特別是在月經前、懷孕、生產後以及更年期及停經後階段。國外已有多篇研究指出針灸對於焦慮疾患的改善有不錯的效果。由於耳穴貼壓具有簡易操作及非侵襲性的優點，故我們的興趣為探討耳穴貼壓合併藥物治療對於更年期及早期停經後婦女焦慮症狀改善之臨床效益。
方法 本臨床試驗採取隨機雙盲的方式，選擇40至60歲之更年期及早期停經後伴隨有焦慮和失眠症狀之婦女，收案44人，分成實驗組(耳穴貼壓組)和對照組(非真實的耳穴貼壓組)二組，在雙耳的神門和皮質下穴位貼上含有磁珠或沒有磁珠之膠布，每週更換二次，總共更換8次為期4週的療程。療效的指標主要是評估焦慮症狀之改變，由Hamilton Anxiety Scale (HAMA) 來評量；次要的指標是比較更年期症狀之改變，由Menopause Rating Scale (MRS) 來評量，生活品質之改變由Short Form 36 (SF-36)來評量，臨床整體印象的評分由Clinical Global Impression-Severity (CGI-S)及Clinical Global Impression-Improvement (CGI-I) 來評量。
結果 兩組在基本資料如年齡、教育程度、生產人數、初經年齡、更年期及停經狀態並無明顯差異。試驗開始時的濾泡刺激素(FSH)值、健康量表分數無顯著差異，另外在先前使用過荷爾蒙者對照組比實驗組多。治療前後分別在焦慮症狀的改善程度上有顯著差異；兩組的更年期症狀、臨床整體印象的改善程度和嚴重程度、生活品質分數與原本未治療時均有顯著差異。另外在兩組藥物的使用劑量方面，耳穴貼壓組在治療前、治療後的平均劑量減少有顯著差異，而對照組在治療前、治療後的平均劑量並無顯著差異。
結論 本研究顯示耳穴貼壓對於更年期及早期停經後之婦女，在改善焦慮症狀、更年期症狀、臨床整體印象和生活品質上均為有效之療法，然而兩組之間沒有統計上的差異。耳穴貼壓組治療前、治療後的平均劑量的減少有達統計上顯著的差異，因此我們認為耳穴貼壓對於更年期及早期停經後之婦女，在改善焦慮症狀、更年期症狀有有效並值得推廣的。未來持續納入個案進行研究是需要的。
中文關鍵詞：耳穴療法、焦慮、失眠、更年期
Objective: Women are particularly vulnerable to anxiety and insomnia while during several stages in life, especially in the pre-menstruation, pregnancy, postpartum, perimenopause and post-menopause stage. Several studies overseas have already pointed out that the improvement of acupuncture for anxiety disorders is pretty good. As auricular acupressure has the advantages of simple operation and non-invasiveness, our interest is to explore the clinical benefit of combining auricular acupressure and medication for anxiety in perimenopausal and early post-menopausal women.
Methods: This study is a double-blind, randomized and controlled study. Forty-four women of 40 to 60 years old, during perimenopause or early post-menopause who were bothered by anxiety symptoms. They were randomly divided into experimental (auricular acupressure) and control (sham acupressure) groups, received patches with or without magnetic beads on shenmen and subcortex acupoints of bilateral ears. A total of eight times treatment and a period of four weeks. Primary outcome measure is based on the change of total score of Hamilton Anxiety Scale (HAMA). Secondary outcome measure is based on the change of total score of Menopause Rating Scale(MRS); change of Short Form Health Survey (SF-36) scores to evaluate quality; changes of Clinical Global Impression-Severity (CGI-S) scores and Clinical Global Impression-Improvement (CGI-I) scores.
Results: There was no difference in demographic data such as age, education, parity, mechare, perimonopause or postmenopause stage. There was no difference in FSH level and scores of BSRS before entering study. There was more cases with prior using hormone in the control group. After treatment, subjects in both groups showed statistically significant improvements on anxiety, menopausal symptoms, clinical impression of improvement and severity. Regarding to the dosage of drugs, the average dosage decreased in auricular acupressure group with statistical significance, however, it was not in the control group. there was no difference between the real acupressure and sham acupressure groups.
Conclusions: Our study shows that both auricular acupressure and sham acupressure are effective treatments for anxiety symptoms, menopausal symptoms and quality of life in perimenopausal and early postmenopausal women, however, there are no statistical differences between the two groups. The average dosage decreased in auricular acupressure group with statistical significance. Therefore, we suggest that auricular acupressure can improve anexiety symptom in perimenopausal and early postmenopausal women. Further studies with more cases are needed.
Key words: Auricular acupressure; Anxiety; Insomnia; Perimenopause |
